RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00194
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Armor Crewman, medically separated for “chronic right foot pain,” with a disability rating of 0%.

CI CONTENTION: His condition continues to worsen.  His complete submission is at Exhibit A.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

SERVICE PEB – 20050128	VARD - 20060207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Foot Pain	8799-8723	0%	Reflex Sympathetic Dystrophy, Right Lower Extremity	8699-8623	10%	20051019	
COMBINED RATING:  0%	COMBINED VA RATING OF ALL CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Right Foot Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right foot pain began after initial foot surgery in 1995 and worsened after a second surgery in 1996.  Electro-diagnostic studies performed in January 1998 revealed a right-sided neuropathy of the deep peroneal nerve.  Despite extensive specialty care and numerous local pain-reducing procedures, the CI’s chronic foot pain condition did not result in improvement sufficient to allow unrestricted duty and he was referred to a MEB.   The MEB forwarded “right foot pain” for PEB adjudication.  At the MEB NARSUM examination performed on 21 December 2004 (4 months prior to separation) the CI endorsed continued right foot pain resulting in his inability to wear typical field gear in respect to any chemical MOP footwear along with his usual combat boots.  His foot-focused physical examination (PE) revealed hyper-sensitivity surrounding the right foot, painful motion, and “decreased motor strength…secondary to pain.”  At the VA Compensation and Pension (C&P) examination performed on 19 October 2005, (6 months after separation) the CI reported right foot pain that extended into the toes and right ankle.  His PE revealed an antalgic gait, moderate tenderness, and painful motion of the right foot.  Activities of daily living were not adversely affected.  There was no documentation of global foot range of motion (ROM) within 1 year either side of separation.  

The Board directed its attention to its rating recommendation based on the above evidence.  Although using different but similar VASRD codes, both the PEB and VA analogously rated the right foot condition under the nerve code corresponding to the anterior tibial nerve (deep peroneal) as neuralgia at 0% by the PEB and neuritis by the VA at 10%; citing moderate, incomplete foot movement.  Board members deliberated and agreed that in light of an identified neuropathy of the deep peroneal nerve as well as hyper-sensitivity symptoms of the entire foot indicating multi-nerve inflammation, therefore, the rating is best representative of VASRD analogous code of 8623 (neuritis deep peroneal) at 10% (moderate).  Additionally, there was evidence of painful motion supporting a 10% rating based upon VASRD §4.59, however this provided no advantage to the CI.  The Board also considered an alternative VASRD code of 5284 (foot injury; other) IAW §4.71a in support of moderate impairment at 10%, again with no advantage to the CI.  All members agreed that in light of the CI’s ability to maintain activities of daily living, this level of activity would not support the 20% rating of “moderately severe” under VASRD code 5284.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was no evidence within the case file that would rate this condition greater than 10%.  Therefore, the Board recommends a disability rating of 10% for the right foot condition.

BOARD FINDINGS:  In the matter of the right foot condition, the Board unanimously recommends a disability rating of 10%, analogously coded 8699-8623 IAW VASRD §4.124a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Chronic Right Foot Pain	8699-8623	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAMR-RB										

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

21 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018515 (PD201500194)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA